PMID- 34646176
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240403
IS  - 1664-0640 (Print)
IS  - 1664-0640 (Electronic)
IS  - 1664-0640 (Linking)
VI  - 12
DP  - 2021
TI  - MDMA-Assisted Therapy as a Means to Alter Affective, Cognitive, Behavioral, and 
      Neurological Systems Underlying Social Dysfunction in Social Anxiety Disorder.
PG  - 733893
LID - 10.3389/fpsyt.2021.733893 [doi]
LID - 733893
AB  - Social anxiety disorder (SAD) is a prevalent and often debilitating psychiatric 
      disorder that can assume a chronic course even when treated. Despite the 
      identification of evidence-based pharmacological and behavioral treatments for 
      SAD, much room for improved outcomes exists and 3,4-methylenedioxymethamphetamine 
      (MDMA) has been proposed as a promising adjunctive treatment to psychological 
      interventions for disorders characterized by social dysfunction. A small 
      randomized, placebo-controlled trial of MDMA-assisted therapy (MDMA-AT) for 
      social anxiety in autistic adults offered encouraging results, but more research 
      is sorely needed to explore the potential for MDMA-AT in treating SAD. This 
      review aims to stimulate future study by summarizing research on disruptions in 
      neurological, perceptual, receptive, and expressive systems regulating social 
      behavior in SAD and proposing how MDMA-AT may alter these systems across four 
      domains. First, we review research highlighting the roles of social anhedonia and 
      reduced social reward sensitivity in maintaining SAD, with specific attention to 
      the reduction in positive affect in social situations, infrequent social approach 
      behaviors, and related social skills deficits. We posit that MDMA-AT may enhance 
      motivation to connect with others and alter perceptions of social reward for an 
      extended period following administration, thereby potentiating extinction 
      processes, and increasing the reinforcement value of social interactions. Second, 
      we review evidence for the central role of heightened social evaluative threat 
      perception in the development and maintenance of SAD and consider how MDMA-AT may 
      enhance experiences of affiliation and safety when interacting with others. 
      Third, we consider the influence of shame and the rigid application of shame 
      regulation strategies as important intrapersonal processes maintaining SAD and 
      propose the generation of self-transcendent emotions during MDMA sessions as a 
      mechanism of shame reduction that may result in corrective emotional experiences 
      and boost memory reconsolidation. Finally, we review research on the role of 
      dysfunctional interpersonal behaviors in SAD that interfere with social 
      functioning and, in particular, the development and maintenance of close and 
      secure relationships. We discuss the hypothesized role of MDMA-AT in improving 
      social skills to elicit positive interpersonal responses from others, creating a 
      greater sense of belonging, acceptance, and social efficacy.
CI  - Copyright (c) 2021 Luoma and Lear.
FAU - Luoma, Jason
AU  - Luoma J
AD  - Portland Psychotherapy Clinic, Research, and Training Center, Portland, OR, 
      United States.
FAU - Lear, M Kati
AU  - Lear MK
AD  - Portland Psychotherapy Clinic, Research, and Training Center, Portland, OR, 
      United States.
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20210927
PL  - Switzerland
TA  - Front Psychiatry
JT  - Frontiers in psychiatry
JID - 101545006
PMC - PMC8502812
OTO - NOTNLM
OT  - MDMA-assisted therapy
OT  - shame
OT  - social anhedonia
OT  - social anxiety disorder
OT  - social functioning
OT  - social threat
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2021/10/15 06:00
MHDA- 2021/10/15 06:01
PMCR- 2021/09/27
CRDT- 2021/10/14 06:33
PHST- 2021/06/30 00:00 [received]
PHST- 2021/08/31 00:00 [accepted]
PHST- 2021/10/14 06:33 [entrez]
PHST- 2021/10/15 06:00 [pubmed]
PHST- 2021/10/15 06:01 [medline]
PHST- 2021/09/27 00:00 [pmc-release]
AID - 10.3389/fpsyt.2021.733893 [doi]
PST - epublish
SO  - Front Psychiatry. 2021 Sep 27;12:733893. doi: 10.3389/fpsyt.2021.733893. 
      eCollection 2021.